The vision behind this is clear: precision psychiatry based on multimodal data sets – thereby fundamentally advancing diagnosis, treatment, and prevention. What is already a reality in oncology should also become possible in psychiatry: identifying subgroups, predicting disease progression, tailoring therapies, and helping patients early and effectively.
In two interviews, Prof. Marion Leboyer (Fondation FondaMental) and Prof. Peter Falkai (DZPG) provide insights into the structure, working methods, and goals of their respective centers — and show how bundled national strengths can create an international research advantage. Together, they are laying the foundation for a transnational infrastructure that closely links science and care and paves the way for a new generation of research in the service of mental health.
FondaMental and DZPG: Cross-border cooperation for better psychiatric care
Interview with Prof. Marion Leboyer
Professor of Psychiatry, Head of the Department of Psychiatry and Addiction Medicine at the Hôpitaux Universitaires Henri Mondor and Scientific Director of the Fondation FondaMental.
Prof. Leboyer, could you start by introducing us to the model of the Centres Experts in France? How do these centers differ from traditional psychiatric care facilities, and how is the Fondation FondaMental embedded in the national care and research structure in France?
The Centres Experts were founded in 2010 and are coordinated by the non-profit Fondation FondaMental. They form a third level of care in the French psychiatric system and are based on the model of reference centers for rare diseases. We currently coordinate 55 centers throughout France, which are organized into four networks (bipolar disorders, schizophrenia, treatment-resistant depression, and autism without intellectual disability) and embedded in public psychiatric departments. Patients are systematically asked if they would like to participate in research projects. This has enabled the formation of large multimodal cohorts that are available for collaboration (access to research data | La Recherche | Fondation FondaMental). Finally, the FondaMental Foundation oversees national coordination, the harmonization of methods, and the important link between care and research.
How do patients get to the Centres Experts and what happens then?
Patients are referred by their psychiatrist, general practitioner, or another specialist. During a two-day stay, they benefit from a standardized, multidisciplinary assessment and receive detailed feedback in which we make personalized recommendations. These personalized recommendations —psychotherapeutic and somatic in nature — are forwarded to the referring physician to ensure continuity of care.
Which clinical pictures or patient groups are the focus of these centers in France?
The centers of expertise focus on complex cases of schizophrenia, bipolar disorder, treatment-resistant depression, and autism without intellectual disability. Patients undergo comprehensive, standardized examinations by multidisciplinary teams of psychiatrists, neuropsychologists, and specialized nurses. The results lead to tailored treatment recommendations, which are forwarded to the referring physician. Since the centers of expertise were established, more than 10,000 patients have been examined. This has helped to reduce residual symptoms and the number of readmissions, improve the detection of comorbidities, and create personalized treatment plans.
Together with the DZPG, you are working on harmonizing data and standards for cross-border research. What are the biggest opportunities here?
Collaboration with the DZPG makes it possible to standardize clinical assessment and data collection between French and German centers, allowing for future comparisons between different settings and populations. This harmonization also facilitates the integration of data from different cohorts and promotes translational research by accelerating the application of scientific findings in clinical practice. It also contributes to the development of targeted and personalized treatments tailored to the individual needs of patients. Furthermore, this approach strengthens collaboration between researchers, clinicians, and institutions by creating a common framework for better understanding complex mental disorders and improving the quality of care worldwide.
In this context, we have recently launched a Franco-German consortium that brings together French centers of expertise and German centers of excellence within the DZPG network. This strategic alliance aims to jointly identify and validate a new generation of biomarkers — genetic, inflammatory, metabolic, cognitive, and digital. To this end, large, harmonized data cohorts from both countries will be compared and advanced AI-supported analysis methods will be applied.
A big task. What will be the initial focus and what are the goals?
The initial focus of the collaboration will be on the application of AI in the search for biomarkers for mental disorders. This will be done by converting data into synthetic data and organizing a hackathon on biomarker discovery in the coming months.
Beyond biomarker discovery, the consortium also aims to build interoperable data infrastructures and predictive models that enable earlier diagnosis, more accurate stratification of patient groups, and personalized therapy decisions.
Ultimately, the goal is to accelerate the development of precise psychiatric tools and ensure that innovative diagnostic and treatment methods quickly reach patients across Europe.
Where do you see the biggest challenges in international harmonization — e.g. in terms of data protection or clinical routines?
A key challenge will be to harmonize data protection regulations and clinical practices across different countries. This includes ensuring the confidentiality of patient data and informed consent. Another challenge is the standardization of diagnostic tools and the harmonization of methods for measuring various biomarkers. This approach requires careful coordination and sustained collaboration between institutions, clinicians, and researchers at the national and international level, taking into account legal, ethical, and cultural differences. Overcoming these challenges is a prerequisite for promoting collaboration in psychiatric research and accelerating clinical progress for the benefit of patients.
The term “precision psychiatry” comes up again and again. How do you define it, and what makes it so important to you for the future of psychiatry?
Precision psychiatry aims to supplement categorical diagnosis with stratification or prognostic biomarkers, including genetic, biological, environmental, and clinical factors.
This approach attempts to identify more homogeneous subgroups within heterogeneous disorders in order to offer targeted therapeutic strategies. This enables improved treatment efficacy, fewer side effects, better guidance for clinicians in individual decision-making, and paves the way for a more personalized and effective future in psychiatric care.
Can you give examples of where the work of the Centres Experts has already brought concrete progress toward precision psychiatry?
In terms of research, the networks of expert centers — including some of the world's largest cohorts — have produced over 200 international scientific publications in just ten years. This underscores the dynamism and impact of their research.
Using longitudinal data sets, we were able to assess the impact of the assessments and recommendations made at an expert center, including: improved treatment adherence, increased prescription of psychosocial therapies, lower rehospitalization rates, improved overall functioning, and more systematic identification of psychiatric and somatic comorbidities (such as metabolic syndrome).
A key objective is to establish large, well-characterized cohorts. What are the most important steps to take in France to build such cohorts and make them available for international research?
The establishment of large, high-quality cohorts requires strictly standardized data collection, comprehensive clinical, biological, and psychosocial assessments, and the use of secure and interoperable databases. Regular longitudinal studies are essential to document the course of diseases, evaluate the effectiveness of interventions, and identify different clinical courses.
Strict adherence to ethical and legal standards, particularly with regard to data protection, must be ensured. Interrater reliability, reviewed twice a year, and the harmonization of standards, both clinically and digitally, are also crucial to enable the integration and comparison of data at the international level. Finally, collaboration with foreign partners paves the way for global research projects while strengthening local patient support.
One of the main concerns of cohorts is to ensure that they prove their worth in the long term. Thanks to the “France 2030” program, we have been selected to set up a French program for precision psychiatry. This enables us to build a nationwide multimodal cohort for all severe psychiatric disorders, which is also accessible for international collaborations.
How important do you consider technologies such as machine learning or AI-supported prediction models to be in psychiatric research and care?
Technologies such as machine learning and artificial intelligence are becoming indispensable tools in psychiatric research. They enable the analysis of complex, multimodal data sets — including data from brain imaging, genetics, behavior, and the environment — to identify patterns, biomarkers, and predictors that often remain invisible in traditional clinical observation.
These tools help identify patient groups and potential therapeutic targets, ultimately improving physicians' ability to provide evidence-based, personalized care with the goal of more accurate diagnosis and individualized treatment. Ethical considerations remain important: AI must be used transparently, and patient consent and data confidentiality must be ensured. Responsible use requires continuous assessment of systematic biases, fairness, and accountability to ensure that these technologies improve care for all patients equally and effectively.
In your opinion, what is needed politically or socially to make the vision of cross-border precision psychiatry a reality?
The establishment of French-German precision psychiatry requires bilateral support from research organizations, strong political commitment, and earmarked private and public funding. It is equally important to raise public awareness of the benefits of personalized psychiatric care. Together, these steps will ensure that advances in precision psychiatry lead to tangible improvements in patient care.
Advancing Precision Psychiatry: A French-German Consortium to Structure a Reproducible Model
Interview with Prof. Peter Falkai
Professor of psychiatry, Chair of the Department of Psychiatry at the University of Munich and spokesperson for the German Centre for Mental Health (DZPG)
Could you explain how the centres of excellence in Germany operate, specifically regarding their geographical distribution and the operating model they follow?
The German Centres of Excellence were selected through a multi-step national selection process. Initially, around 20 university-hospital networks submitted their applications. From these, 14 were shortlisted, and finally, after interviews supported by European support, 6 centres were selected. Each centre represents a network and is designed to ensure wide population coverage. For example, the Munich centre alone serves a catchment area of approximately 6 million people.
Together, the six centres cover, through prospective studies to include patients from all 6 centres, half of Germany’s population. However, it is worth noting that the northern regions are less represented in this network.
Funding has been allocated not only for ongoing infrastructure but also for special projects and, with a plan extending over 7 to 8 years for financial support. This financial stability allows us to consistently monitor and improve or stabilize mental health outcomes.
Our model includes integrating general practitioner (GP) networks, where selected individuals suffering from mental illness can receive short interventions up to four times. Another example involves identifying individuals who have experienced childhood abuse to provide them with targeted treatment.
The goal of the centres is to measure mental health in Germany, improve it and focus on prevention (especially secondary range).
Although the centres are not each specialized in a specific mental illness – as is the case for the FondaMental Foundation’s Centres of Expertise –, they all cover a broad range of psychiatric conditions. Similarly, our primary focus areas are major psychiatric disorders: depression, bipolar disorder and schizophrenia, but we also address all other disorders such as personality disorders. Geriatric psychiatry and dementia fall outside this remit and are covered by a dedicated additional centre.
What are the main challenges and opportunities in replicating the French expert centers in Germany?
It is a great opportunity to join forces across countries, as we are currently doing with Germany and France, and to replicate findings and expand our cohorts, thereby increasing the reliability and clarity of our data to further develop precision psychiatry, specialized, patient-centered approach that tailors diagnosis and treatment to subgroups of individuals sharing similar clinical, biological, or behavioral characteristics.. Larger and better-characterized cohorts could significantly enhance research. Currently, cohort data can be quite heterogeneous.
Using tools like machine learning, we could enrol new patients and match them across cohorts, both French and German, based on clinical, imaging, genetic, and biological characteristics. This would strengthen research and move us closer to precision psychiatry.
However, key challenges include harmonizing both existing and future cohorts and ensuring they are large and uniform enough to detect meaningful patterns across the wide range of mental disorders. Collaborations like the one initiated by Marion Leboyer’s cohort club, [a project under the PEPR Propsy initiative (France 2030) which aims to create a global mapping of longitudinal cohorts in psychiatry in order to make metadata on these cohorts publicly available] are essential in this regard.
What is the future of neurobiological research on mental disorders, and what breakthroughs are needed to advance the field?
A major priority is to better understand the underlying mechanisms of mental disorders, much like in the field of oncology has done by identifying hormone receptors behaviours to guide treatment. We need similar breakthroughs to define mental disorder phenotypes and underlying mechanisms.
Once we understand these mechanisms, we must develop biomarkers that correlate with them. For example, in dementia, the presence of specific deposits in the brain, such as amyloid plaques, serves as a biomarker indicating the presence of the disease. These biomarkers linked to disease mechanisms will help us distinguish subgroups within disorders and eventually lead to mechanistically informed, tailored treatments.
Collaborative networks are vital as they allow for consent, cohort development, and data management. However, sustaining them requires long-term investments from the government.
What role do large, multilayered cohorts (integrating behaviour, brain analysis, genetic and non-genetic factors) play in driving precision psychiatry?
They are essential. You can test hypotheses in small samples, but to generalize those findings, large, well-structured, multilayered cohorts are necessary. These should integrate behavioural data, brain imaging, genetic, and non-genetic information to identify mechanistically defined subgroups and improve treatment accuracy.
How can international cooperation between research centres, such as those in Europe especially between France (Fondation FondaMental) and Germany and beyond, optimize the use of tools, data, and essential technologies like machine learning?
The first step is agreeing on a common set of measurement tools. Then, we must combine datasets from different centres, ensuring they are anonymized and standardized. Ideally, these should be blinded, so researchers don’t know which data comes from which country and made open source to promote wide scientific collaboration on predictive calculation regarding perspective studies and cohort analysis.
What steps are needed to align research efforts, define shared frameworks, and identify key mechanisms to support precision psychiatry initiatives?
There are three main steps: 1. Agreement on methodology: align methodologies and data collection standards in the existing cohorts. 2. Assemble large, multilayered cohorts. 3. Calculate: use the cohort to make predictive models, identify homogeneous subgroups, discover relevant biomarkers, and test targeted treatments.
The original interview with Prof. Peter Falkai appeared at: https://www.fondation-fondamental.org/actualites/faire-progresser-la-psychiatrie-de-precision-un-consortium-franco-allemand-pour
